Lengthening of the tibia over an intramedullary nail, using the llizarov external fixator: Major complications and slow consolidation in 9 lengthenings

Kristiansen, Leif Pål; Steen, Harald

doi:10.3109/17453679908997806

Cited by 82 publications

(60 citation statements)

References 7 publications

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“…The classic method confers several disadvantages such as prolonged time in a frame and high risk of fracture of the new bone after frame removal [5][6][7]. During the latter procedure, an intramedullary nail was inserted concomitantly with the external fixator [8,9]. At the end of the distraction phase, the nail was locked by inserting two distal screws and the external fixator was removed.…”

Section: Introductionmentioning

confidence: 99%

S-osteotomy with lengthening and then nailing compared with traditional Ilizarov method

Lan

Zhang

Tang

et al. 2013

International Orthopaedics (SICOT)

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Purpose The purpose of this study was to explore the clinical effect of the novel method combined longitudinal S-osteotomy and Lengthen And Then Nail (LATN) technique for leg lengthening and compare with the classic Ilizarov method. Methods This retrospective study was performed from March 2008 to April 2012. A total of 176 leg lengthenings (88 consecutive patients) were performed at our institution. The mean duration of follow-up was 2.2 years (range, one to four years). In group A, 78 tibial lengthenings were performed with longitudinal S-osteotomy and LATN technique. In group B, 98 tibial lengthenings were performed with the classic method. The final gain in length, mean surgical time for bilateral tibial osteotomy, the external fixation index and the radiographic consolidation index were calculated and compared. The complications encountered during operation and follow-up were documented. Results There was no significant difference in the final gain in length between the two groups. Mean surgical time in group A (130.05±6.60 min) was significantly longer than that in group B (91.4±6.61 min; P<0.05). External fixation index in group A (21.02±3.16 days/cm) was significantly lower than that in group B (76.19±8.32 days/cm; P<0.05). Consolidation index was significantly lower (more rapid healing) in group A (43.38±5.35 days/cm) than that in group B (76.19±8.32-days/cm; P<0.05). There was a significant difference in pintract problems and axial deviation between the two groups. Conclusion The novel method combined longitudinal Scorticotomy and LATN technique safely reduces the consolidation time, rate of pin-tract problems and axial deviation during leg lengthening, compared with the classic Ilizarov method.

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Section: Introductionmentioning

confidence: 99%

S-osteotomy with lengthening and then nailing compared with traditional Ilizarov method

Lan

Zhang

Tang

et al. 2013

International Orthopaedics (SICOT)

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“…Combinations of intramedullary nails and external fixators also show a high rate of complications in adults [15,25,26,31,35]. A lower complication rate of 11% was reported in children [34].…”

Section: Discussionmentioning

confidence: 99%

Leg Lengthening With a Motorized Nail in Adolescents

Krieg

Speth

Foster

2008

Clinical Orthopaedics &Amp; Related Research

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Leg lengthening by external fixation is associated with various difficulties. We evaluated eight adolescent patients who underwent leg lengthening with a motorized intramedullary lengthening device. We asked whether this method could reduce the time of hospitalization and rehabilitation and whether the incidence of complications commonly associated with external fixators could be reduced. We compared our preliminary results with those from other reports, with a focus on leg length achieved, time of rehabilitation, and rate of complications. The average leg-length discrepancy was 3.8 cm (range, 3-5 cm). The average lengthening distance was 3.8 cm (range, 2.9-4.7 cm). In six patients, leg lengthening was combined with successful correction of the mechanical axis alignment. The consolidation index averaged 26 days/cm (range, 19-41 days/cm). The average hospital stay was 9.6 days. No bone or soft tissue infections were observed. In comparison to other studies (1.0-2.8 complications/ patient), our results suggest that the difficulties commonly associated with external fixators can be reduced with this method. It also allows good angular correction in patients with mechanical axis deviation. These features combined with a short time of hospitalization and rehabilitation make it a promising procedure for limb lengthening.

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“…Complications related to nails have been reported, e.g., deep infection, breakage of nails or interlocking screws, and protrusion of nail heads [10,21]. These complications most commonly occur when the nail diameter is less than 8 mm, in particular when a 6.7 mm unreamed humeral nail is used in the tibia.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, this technique is gaining wider acceptance because of the improvements in patient comfort it offers [7]. On the other hand, Kristiansen [10] reported encountering a high rate of serious complications in patients treated by tibial lengthening over an intramedullary nail, which led them to abandon this technique and return to the classic Ilizarov method. The concept of lengthening over an intramedullary nail is not new.…”

mentioning

confidence: 99%

“…This modality provided additional axial and rotational stability to protect newly formed bone. However, various complications were reported, including cases of deep infection and breakage of nails and locking screws even when a locked intramedullary nail was used [10,21]. The objective of this study was to evaluate the appropriateness and efficacy of a therapeutic approach in which the limb lengthening procedure was conducted through the combined use of an Ilizarov external fixator and a relatively large diameter intramedullary nail by intramedullary reaming in patients with leg length discrepancy or short stature.…”

mentioning

confidence: 99%

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Tibial lengthening using a reamed type intramedullary nail and an Ilizarov external fixator

Kim

Lee

Kim

et al. 2008

International Orthopaedics (SICOT)

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The aim of this study was to evaluate the efficacy of tibial lengthening using a reamed type intramedullary nail and an Ilizarov external fixator for the treatment of leg length discrepancy or short stature. This retrospective study was performed on 18 tibiae (13 patients) in which attempts were made to reduce complications. We used an Ilizarov external fixator and a nail (10 mm diameter in 17 tibiae and 11 mm in one tibia) in combination. Average limb lengthening was 4.19 cm (range, 2.5-5.5). The mean duration of external fixation was 12.58 days per centimetre gain in length, and the mean consolidation index was 40.53 (range, 35.45-51.85). All distracted segments healed spontaneously without refracture or malalignment. Gradual limb lengthening using a reamed type intramedullary nail and circular external fixation in combination was found to be reliable and effective and reduced external fixation time with fewer complications.

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Lengthening of the tibia over an intramedullary nail, using the llizarov external fixator: Major complications and slow consolidation in 9 lengthenings

Cited by 82 publications

References 7 publications

S-osteotomy with lengthening and then nailing compared with traditional Ilizarov method

S-osteotomy with lengthening and then nailing compared with traditional Ilizarov method

Leg Lengthening With a Motorized Nail in Adolescents

Tibial lengthening using a reamed type intramedullary nail and an Ilizarov external fixator

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